15956 - Laserfiche WebLink

Home Browse Search

w F P OFFIC JS ✓ L Permit No. PERMIT . I • � 4APPLICATION FOR SANITATION PERM ----- -- _---------II-- (Complete in Duplicate) Date Issued ... -------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 554499.,, JOB ADDRESS A LOCATION- '---- ----------- ---------- -- / __.._ Owner s Name-------•-- --•-----•I'---- ---- --- - --------- -------•---- - •---------------------•-------------------------- ---------- Phone-------_------------_-------•---- ' -------------------------- -----------------------.......................•••-- ----III-- •-............. Address----------- ---------- - -------- -- ------ ------ �� a•-.�,. __ � --- Phone Name..............____ _ __ _ Installation will serve:, Residbnce [Apartment House ❑ -Commercial-[j Trailer Court ❑ Motel ❑ Other ❑ ` , p d ••••--------- -------------------- Number of living unit.: .• Number of bedrooms _ _ Number of aths . ___ Lot size ___ _ -.-- Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table f i Character of soil to a dept: of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay Adobe❑ Hardpan ❑ Made:: I If es date___.___.._.___.__--) No ❑ New Construction: Yes ❑ No Clay Yes ❑ No ❑ Previous Application M i��( yes, TYPE OF INSTALLATION AND SPECIFICATIONS: ir No septic tank or cesspool permitted if public sewer is available within 200 feet.) i I m ------------------- T. __.Material---------------------. .._______.......-___._..._._`. Distance from nearest we ______________ sa No. of ompartments--------------------- ---Size__.--------------------------------Liquid de.th ---------------------Capacity ._....__.....__ �i1Distance from foundation_._ —S........ to nearest lot line/4-.4--. Disposal Field: Distance from nearest well [ � NumbeFf d of lines-------- ---------- Length of each (ine_______________ ._....Width of trench___. Type of filter material. - -- p __f----Total length ------- Type th`of,filter material_.- 9 r I : Seepage Distance to nearest well_` __------.Distanc m f undation...,J --•- .Distanc�to nearest loft line./_4 `_ Size: Diameter---- De th----------------- _ ----• Number of pits--- material. 6 P -R 1 • l !I. a' Cesspool: Distance from nearest well_________ ______Distance from.foundation.._._____--__- ___.Lining material_____.____._______.___...._________. P ----'----Depth----•'--^--------- �' ---------•-Li Liquid Ca Capacity -- gals, Size: D:iameter-- ----------------------- � -----:--------- -- q P ---•--------- � Privy: Distance from nearest well _________________-------------------------------Distance from nearest building_____-___.___-__-__---____________--____-- ❑ II j ----------------------------- -------------------------- Distance to nearest lot line ------------- --------------•--------•---------------••-•--------------•-----•--- Ili t Remodeling and/or repair�iYlg (describe):-------- ----------------------------- --------------------------------;----------••-------•-•- -••-------•---------------.........- ..� . •--------- ----------------•- - -------------------------------------------- -------------- 'p-------------•----------------- ---------------------------------------------------------___---------- ' 1 he by c rtify hat I havt3 prepared t application and that the work will be done in accordance with San Joaquin County ordinan s Sta s, an'd rules nd regul ons of t e San Joaq in#faacal H alth District. St ned ---- - - -----`-------- -- -- --- ------- --- --------------------------4_7,wner and/or Contractor)( �9 ) ---------------!`•--------------------- �N ---------- ------- -- ------ ------------------(Title)-- --r----------- ------------- -------------- (Plot plan, showing size of Mot, location of sys em in relation to well ui dings, etc., can be placed on reverse side). FOR DEPARTM T USE ONLY !,, / � '�`�------------------------------------------------------ DATE: 1 1�G "---------------------- APPLICATION ACCEPTED BY_REVIEWED BY------••----------��- ----------------------------------------------------- DATE------------------------------------•----------------•------ BUILDING PERMIT ISSUED--------•---------------------------------------- •-----------------•------- DATE Alterations artd or recommend'ations:__.-__ �� --:� `'" `= ••--j` •---- > -----------------------_----- -------------------------------------------------------------------....... --------------------------- c tel. / FINAL INSPECTION BY: ------ - -��---- -- ---------"��------------• Da ------- ------------------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 114 Sycamore Street 405 West 91h Street Stockton,California 1 Lodi,California Manteca,California Tracy,California . ES 9 REVISES 8-59 2M 5-62 ATLAS -